Malignant melanoma brain metastases. Review of roswell park memorial institute experience

Abstract

Institute from 1972 to 1978 were found to have brain metastases. Seventy-three percent of the patients had multiple brain metastases. Male to female ratio was 1.9:l. The median survival of the untreated group of patients was 3 weeks as compared with that of 6 weeks for the patients maintained on steroids only, 9 weeks for those who received radiotherapy, 11 weeks for the patients treated with intraarterial chemotherapy, and 26 weeks for the patients who underwent successful surgical excision of a solitary lesion.Cancer 53:2550-2552, 1984.ALIGNANT MELANOMA, in its advanced Stages, is a M devastating disease capable of metastasizing to ev-From the Departments of Neurosurgery and Soft Tissue Melanoma,

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

“…The median overall survival of approximately 7 weeks is similar to that quoted by other authors who have reported median survivals of between 9 and 20 weeks (Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper, 1986;Barth et al, 1995;Gupta et al, 1997;Ellerhorst et al, 2001). Clearly, in a situation with such a poor prognosis, it is important to attempt to deliver treatment according to rational guidelines based on the likelihood of gaining a palliative benefit.…”

“…The largest reported series of WBRT in MMM is by Sampson et al (1998) who treated 180 patients with a median survival of 120 days. Other smaller series report similar median survivals in the range of 9 -20 weeks (Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper, 1986;Barth et al, 1995;Gupta et al, 1997;Ellerhorst et al, 2001). Numerous studies of the effects of fraction size on palliation and survival have failed to demonstrate a survival advantage and many authors recommend a total dose of at least 30 Gy (Ellerhorst et al, 2001).…”

“…Many studies show improved survival in those undergoing resection and also in those with no extracranial metastases (Katz 1981;Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper 1986;Skibber et al, 1996;Ellerhorst et al, 2001). A series of 91 patients undergoing surgical resection of MMM brain metastases showed that the outcome was better if the patient had no neurological deficit, a single supratentorial site and no lung or visceral metastases.…”

Temozolomide in advanced malignant melanoma with small brain metastases

“…16 The reported objective response rates of symptomatic brain metastases from melanoma to WBRT range from 11% to 14%. 2,[7][8][9][10]16 These data indicate that WBRT is of little benefit in the majority of patients who have symptomatic brain metastases from melanoma. In addition, the duration of such treatment will take a substantial part of the rest of these patients lives, and its side effects, like fatigue, nausea, and hair loss, signify an additional burden for these patients.…”

“…[4][5][6] The standard treatment for patients with symptomatic brain metastasis and active extracranial metastases consists of whole-brain RT (WBRT) in combination with corticosteroids that, nonetheless, is barely effective (the median survival is about 3, and most treated patients dye of neurologic disease). 1,2,[7][8][9] In fact, the objective response rate of symptomatic brain metastasis from melanoma to conventional WBRT probably is not greater than 15% 7,10 ; and, for the majority of patients, the burden of such treatment may have more negative impact on the quality of life than the doubtful benefit to survival compared with corticosteroids and other supportive measures. Data about the efficacy of RT in patients with asymptomatic brain metastasis from melanoma are lacking.…”